RN Autonomy

  1. How many RN's on this board feel they have a decent level of autonomy in their nursing practice? I ask this question, because it seems to me that hospitals are setting up standards of care that take away nursing judgement. I am sure that in the critical care environments nurses still have decision making ability. However, from my experience in step down units and general med-surg units, it seems like nurses are not allowed to make judgements about care and treatments like we use too.

    Perhaps this is a change happening now in acute care related to all the new graduates being hired and nursing shortage as well as the legal climate today. But it really drives me nuts when I am not allowed to make a nursing judgement because there are protocols already in place. While I think protocols are fine, I believe that patients come in all different shapes, sizes and clinical presentations. Protocols do not always fit everyone and there are times when sound clinical judgement should be used.

    Just a question. Thanks for your response.
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  2. 4 Comments

  3. by   danemeth
    I am a male RN and have been in different positions for many years. First I would like to say that there are good Nurses out there. There are alot that are incompetent and cover their asses. Hospital administrators do not care about Nurses that is their job to belittle us and work us to the point of death. If Nurses could submit a bill to the insurance for their time and we could have a hospital billing office then we would have autonomy. Thats just my 2 cents. As long as we cost the hospital money we will be belittled and treated as handmaidens for the Doctors.

    also continuing education should be promoted and staff should encourage each other instead of discouraging each other. MD's have collegiality, Nurses do not for the most part. Then you have some nurses from other countries that keep to themselves and do not join the American culture. Then as a male Nurse you are treated with disrespect or as a plaything to be rubbed on at work.

    So hospital administration and a weak department of Nursing is the reason Nurses are treated like ****. Everybody is afraid to stand up or they will be be fired by administration and it happens alot. I like nursing, but if I knew what to expect I think I would have tried something else with my life.

    Best of luck
  4. by   lkwashington
    Danemeth I totally agree with you. I have worked on a unit for almost 6 years. I have been a nurse for over 3. For almost 6 years being on the unit I have head 6 clinical coordinators and 3 directors. I feel there is stability on the unit. I have thrown too many policies to sign I feel it has taken me from the bedside. The mandatory meetings are repeating themselves and nothing not being done. I am tired of the politics on the unit. Some nurses are not willing to learn and they just do what they want. So I decided that I am going to travel. I dont have to worry too much about the above statements.
  5. by   kimmie4476
    I think it depends on where you work, for instance, I work in a small rural hospital where we have very few protocols in place, so we use nursing judgement a lot. The doctors here know each one of us personally and our capabilities, which helps, but in a bigger hospital, where people you don't know are taking care of your patients (as the Dr.) it would be scary having some unknown nurse use their judgement without consulting you. Each nurse is different as to what skills they have, some are book smart, some have common sense, some are task oriented and some can see the big picture. This is why there are protocols in place..they tell you this is what to do and if in your judgement it is the wrong thing to do, then you call the MD and get an order to change it. CYA all the way
  6. by   RNperdiem
    Some judgments have been altered over the years.
    Before insulin drip protocols, nurses in my unit would freely titrate insulin drips by judgment rather than a set protocol. "Hmm... lets go up by, uh, how about another 2 units an hour".
    This level of autonomy works only if the nurses have good judgment.
    Patient safety often results in standardization.

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